GUT ENDOTOXIN RESTRICTION IMPROVES POSTOPERATIVE HEMODYNAMICS IN THE BILE-DUCT-LIGATED RAT

Background: Postoperative hemodynamic disturbances in obstructive jaun dice are associated with complications such as shock and renal failure . Gut-derived endotoxemia may underlie these complications. Recently, we have shown that cholestyramine treatment prevents gut-derived endot oxemia in bile duct-ligated (BDL) rats (Houdijk APJ, Boermeester MA, W esdorp RIG, Hack CE, van Leeuwen PAM: Tumor necrosis factor unresponsi veness following surgery in bile duct-ligated rats. Am J Physiol 271: G980-G986, 1996). Methods: The effect of cholestyramine on systemic he modynamics and organ blood flows after a laparotomy was studied in 2 w k BDL rats using radioactive microspheres, Results: Compared with sham -operated rats, postoperative BDL rats had 1) lower blood pressure (p <.05) and heart rate (p < .001) with higher cardiac output (p <.05), 2 ) lower splanchnic blood flow (p <.05), 3) lower renal blood flow (p < .01), and 4) higher splanchnic organ and renal-vascular resistances. C holestyramine treatment in BDL rats prevented the postoperative decrea se in blood pressure by increasing cardiac output (p <.01). In additio n, cholestyramine maintained splanchnic blood flow at sham levels (p < .05). Furthermore, cholestyramine also prevented the fall in renal blo od flow after surgery in BDL rats. Conclusion: Gut endotoxin restricti on using cholestyramine treatment maintained normal blood pressure, im proved splanchnic blood flow, and completely prevented the fall in ren al blood flow in BDL rats. Reducing the gut load of endotoxin in patie nts with obstructive jaundice scheduled for abdominal surgery may prev ent postoperative hemodynamic complications.